Blistering Eruption on the Subcontinent: The Looming Public Health Threat of Herpes Zoster, ‘Shingles’ in India and the Urgent need for Vaccination

Herpes zoster (HZ), or 'Shingles', caused by the reactivation of the varicella-zoster virus (VZV), is an emerging public health concern globally. While global data indicate a rising incidence of HZ, India lacks robust epidemiological studies, despite estimates suggesting a comparable burden. With India's population above 50 years of age projected to quadruple by 2050, the incidence is expected to rise further. Often accompanied by complications such as post-herpetic neuralgia (PHN), this painful dermatological condition significantly impacts the quality of life, particularly among aging populations. Given the significant burden of HZ and the presence of debilitating complications, vaccination remains the most effective preventive strategy. Despite the global recommendation of zoster vaccines-Zostavax and Shingrix-for individuals above 50 years of age, India has yet to incorporate them into its national immunization program. The lack of public awareness, high vaccine costs, and the absence of national surveillance data hinder widespread adoption. This paper examines the burden of HZ in India, evaluates available vaccines, and highlights challenges to its widespread adoption. It emphasizes the need for comprehensive community-based studies, and public awareness initiatives to drive vaccine uptake. Future advancements in vaccine technology and policy shifts will play a key role in determining the feasibility of large-scale implementation in India, ultimately improving health outcomes and quality of life for millions.